Organization
SOUTH GEORGIA VASCULAR CLINIC
Active
Other names
TIft Regional Medical Center d/b/a South Georgia Vascular Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS CRUM (VP/CFO)
(229) 353-6146
Entity
Organization
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 382-9733
(229) 387-6161
Mailing address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 382-9733
(229) 387-6161
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
031466
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003883612
NPI/WILLIAM KAISER, MD
GA
01
—
1154356889
NPI/BRAD HOLT PA
GA
05
—
205810921C
—
GA
Enumeration date
05/06/2009
Last updated
05/06/2009
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